Monomicrobial gram-negative necrotizing fasciitis: An uncommon but fatal syndrome

• Published in: Diagnostic microbiology and infectious disease 2019-06, Vol.94 (2), p.183-187
• Main Authors: Park, Se Yoon, Yu, Shi Nae, Lee, Eun Jung, Kim, Tark, Jeon, Min Hyok, Choo, Eun Ju, Park, Suyeon, Chae, Joon Won, In Bang, Hae, Kim, Tae Hyong
• Format: Article
• Language: English
• Subjects: Gram-negative; Liver cirrhosis; Necrotizing fasciitis
• ISSN: 0732-8893; 1879-0070
• DOI: 10.1016/j.diagmicrobio.2018.12.013

This study aimed to characterize patients with monomicrobial gram-negative necrotizing fasciitis in three university hospitals in Korea. In this study, of the 115 patients with community-acquired necrotizing fasciitis, 67 (58%) had monomicrobial infections: 31 (27%) in the gram-negative group and 36 (31%) in the gram-positive group. The majority of patients in the gram-negative group were infected with Escherichia coli followed by Klebsiella pneumoniae and Vibrio vulnificus. More patients in the gram-negative group showed liver cirrhosis than those in the gram-positive group (39% vs. 14%, P = 0.02). In a multivariable logistic regression analysis, liver cirrhosis (adjusted odds ratio [aOR], 13.7; 95% confidence interval [CI], 2.9–67.0), treatment with antibiotics without surgery (aOR, 10.2; 95% CI, 2.1–48.3), and lower level of albumin (aOR 4.9; 95% CI, 1.6–14.9) were associated with 30-day mortality. Our findings suggest that gram-negative necrotizing fasciitis is more often associated with liver cirrhosis and has poorer outcomes than gram-positive necrotizing fasciitis.